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How do we reach equality for women? And is it the summit of our aspirations? Contributors to On The Issues Magazine, Summer-Fall 2010 consider equality, double standards and human rights.

Health Inequality: Gates Foundation Bans Abortionby Marcy Bloom

Melinda French Gates, philanthropist, co-founder and co-chair of the Bill and Melinda Gates Foundation, was greeted with great applause on the first day of the Women Deliver conference in Washington, D.C. earlier this summer. But the hand clapping was temporary. As a reproductive health advocate, I was not the only one who began to raise questions about her comments and her foundation's capacity to set the worldwide agenda for global health priorities.
Gates announced that the foundation with her name on it, known for its important work on the prevention of poverty and the development of vaccines for HIV/AIDS and malaria, will designate $1.5 billion over the next five years to assist developing nations with integrated women's health care services.

She explained that this new priority will add to the empowerment, education and equality of women and girls. She described the services: nutrition, pre- and post-natal care, infant care, the training of women's health workers and obstetrical services.

Yes, this is impressive, and will do much good to help women and girls, and to save their lives. But it is silent on a central and fundamental issue for women: access to safe abortion and protection from unsafe abortion.

This is so despite the fact that access to safe abortion was one of "three core strategies to save women's lives" on the agenda of the Women Deliver conference, which was titled Invest in Women. It Pays. In attendance were 3,500 advocates from 140 countries. The goal was to seek out strategies to prevent maternal mortality so that "no person should die giving life." It's critical to note that if you believe in investing in women and girls, no woman or girl should ever die preventing life either. The statistics are stark: approximately 350,000 women lose their lives each year giving birth, from childbirth complications and injuries, and from illegal and unsafe abortions.
All are preventable tragedies.

Let women live

At the conference, the Guttmacher Institute shared the significance of emphasizing the need for both family planning and maternal and newborn health services.

Tragically, only one-half of the 123 million women and girls each year who give birth receive the full range of prenatal, delivery and post-natal care that they need. If women's equality were recognized, and this care were prioritized and funded, women's lives would be vastly improved. Unintended pregnancies around the world would decrease by more than two-thirds, dropping from 75 million (2008) to 22 million per year (still disgracefully high, but certainly an improvement). Seventy per cent of maternal deaths would be avoided. Unsafe abortion rates would decline by 73 percent.

The reality is that these critical needs cannot -- and should not -- be separated. All represent a continuum of women's lives and their reproductive health concerns. Women who have abortions become mothers; mothers have abortions. Safe abortion can help women become better mothers in the future. These are the same women making different choices at different times in their lives.

Illegal, unsafe abortion is a form of violence against women

Illegal, unsafe abortion is a reproductive health crime and a form of violence against women. Ignoring abortion, siloizing abortion, denying its significance as a fundamental public health need for women, is absurd and unrealistic.

As reported in 2006 in the public health journal, The Lancet, abortion is "a pandemic -- an urgent public health and human rights imperative." Nearly 68,000 women and girls die as a result of botched abortions -- this is 13 percent of all maternal deaths. Twenty times that number of women and girls will experience abortion-related complications that threaten their lives. Nearly all (97 percent) of these preventable deaths and injuries are in developing nations. "Access to safe abortion improves women's health," according to The Lancet authors. "Access to competent care" is a critical need, they state.

While the Gates Foundation said that it is interested in funding access to contraception for the 200 million women and girls around the world who are unable to obtain birth control, The Lancet authors underscored: "(T)he availability of modern contraception can reduce but never eliminate the need for abortion."

"Neutrality" leaves no choice

So why is the Gates Foundation ignoring the abortion care needs of women?

In response to a request for comment to the Gates Foundation, a response was emailed from "Deborah Lacy (Independent Contractor)" who said: "While the foundation is making new investments in maternal and child health, our position on funding abortion services has not changed. Specifically, the foundation does not fund abortion and does not take a stance on the issue. We focus on improving access to the tools women need to prevent unintended pregnancy, by supporting organizations that provide voluntary family planning information and services for women in developing countries. Family planning services are critical to prevent unintended pregnancy and reduce abortions."

Does she fear that the image of the foundation will be affected? Fear anti-choice boycotts of Microsoft products? Does she have security concerns? Fret about the moral complexity of women's decision-making? Or does she view women's lives as controversial?

Gates seems unable to understand that the true moral issue is allowing women and girls to die because of lack of access to a safe medical procedure. By trying to avoid the "controversy" surrounding abortion, Gates has created another: it is impossible to work on maternal mortality issues and ignore abortion.

The clear and well-documented reality -- one I have witnessed and experienced for 40 years in my work as an abortion counselor, feminist clinic director and fundraiser for international reproductive rights -- is that safe and legal abortion preserves the dignity and saves the lives of women and girls. Contraception fails. Women change their minds about their pregnancies. Sexual activity is often unexpected, involuntary and unprotected. The misogyny and control demonstrated in sexual violence are part of the lives of far too many women and girls in the world. Without access to safe abortion, women suffer.

Bill and Melinda Gates are undoubtedly aware of these realities of women's unequal lives. The end result of their "neutrality" is but one choice for women and girls who become pregnant. That one choice equals no choice.

Allowing the further stigmatization of abortion validates and strengthens the belligerent anti-choice movement.

But the power and influence of the foundation go further. Because of its prestige, size and assets, the foundation is central to "setting the sexual and reproductive health and rights agenda around the world," in the words of policy researcher and writer Brook Elliott-Buettner in Gender Across Borders.

Whatever the intent, the Gates Foundation is establishing, even distorting, the direction of investments by other foundations, individuals and even governments. Although Bill and Melinda Gates have the right to spend their money as they wish, it is also true that their inordinate power in determining universal health agendas demands accountability.

When they slam the doors to safe abortion initiatives, the impact is felt around the world. The result? These reproductive health crimes against women are permitted to continue, unchecked. The Gates Foundation has chosen to sweep abortion off the charts of women's health and lives. And that is yet another crime against women.

Marcy Bloom worked as an abortion counselor and clinic director in New York, and for more than 18 years served as the executive director of Aradia Women's Health Center in Seattle. In 2006, she received the William O. Douglas Award, the Washington State ACLU's lifetime achievement award. She is currently the U.S representative for the Mexico City-based GIRE - Grupo de Información en Reproducción Elegida (The Information Group on Reproductive Choice), Mexico's leading for for reproductive justice and access to legal abortion.